Superficial Calcium Fracture After PCI as Assessed by OCT

Kubo, Takashi; Shimamura, Kazuo; Ino, Yasushi; Yamaguchi, Tomoyuki; Matsuo, Yoshiki; Shiono, Yasutsugu; Taruya, Akira; Nishiguchi, Tsuyoshi; Shimokado, Aiko; Teraguchi, Ikuko; Orii, Makoto; Yamano, Takashi; Tanimoto, Takashi; Kitabata, Hironori; Hirata, Kumiko; Tanaka, Atsushi; Akasaka, Takashi

doi:10.1016/j.jcmg.2014.11.012

Cited by 94 publications

(59 citation statements)

References 4 publications

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“…We should have evaluated the calcification types, such as superficial calcification, thickness and arc of calcification and calcified nodule, using optical coherence tomography (OCT) or IVUS. In fact, a previous study has reported the beneficial effect regarding the use of rotational atherectomy and coronary imaging devise such as OCT for severe calcified lesion, warranting future studies involving larger populations and longer longitudinal follow‐up periods.…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical outcomes of coronary artery stent implantation in patients with end‐stage chronic kidney disease including hemodialysis for three everolimus eluting (EES) stent designs: Bioresorbable polymer‐EES, platinum chromium‐EES, and cobalt chrome‐EES

Sato

Hatada

Kishi

et al. 2017

J Interven Cardiology

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Section: Discussionmentioning

confidence: 99%

Comparison of clinical outcomes of coronary artery stent implantation in patients with end‐stage chronic kidney disease including hemodialysis for three everolimus eluting (EES) stent designs: Bioresorbable polymer‐EES, platinum chromium‐EES, and cobalt chrome‐EES

Sato

Hatada

Kishi

et al. 2017

J Interven Cardiology

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“…Kubo et al assessed the thickness of calcium fractured by balloon dilation during PCI, showing a maximal calcium fracture thickness of 770 μm [5]. Thus, if a 2.25-mm burr had also been used in this case, complete expansion in the lesion would not have been expected because the calcium to the side of where the burr was passing was extraordinarily thick (approximately 1100–1700 μm) (Fig.…”

Section: Discussionmentioning

confidence: 99%

Optical coherence tomography findings after longitudinal ablation for an underexpanded stent in a heavily calcified lesion: a case report

Koide

Inoue

Matsuo

et al. 2016

BMC Cardiovasc Disord

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BackgroundHeavy coronary artery calcification is responsible for stent underexpansion, which is associated with increased in-stent restenosis. Here we report a case in which optical coherence tomography (OCT) demonstrated that the metal component of an underexpanded stent previously implanted in a heavy calcified lesion had been completely removed after ablation with rotational atherectomy.Case presentationAn 83-year-old man with exertional angina was referred to our hospital. Coronary angiography revealed severe stenosis in the proximal portion of the right coronary artery and left circumflex artery and chronic total occlusion (CTO) in the mid portion of the left anterior descending artery (LAD). We performed complete revascularization with percutaneous coronary intervention. Because the CTO lesion in LAD contained napkin-ring heavy calcifications, rotational atherectomy with a 1.75-mm burr was undergone, followed by the deployment of drug-eluting stents and postdilation with a high-pressure balloon. However, expansion of the stent was incomplete. To address the recurrence of in-stent restenosis and resistance to the dilation with the high-pressure balloon, we decided to simultaneously ablate both the heavy calcification and underexpanded stent. Longitudinal stent ablation with 1.75- and 2.0-mm burrs was successful, and OCT demonstrated that the metallic component of the underexpanded stent had been completely removed.ConclusionIf a stent fails to completely extend in heavy calcification, longitudinal stent ablation by rotational atherectomy could be an effective remedy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0419-8) contains supplementary material, which is available to authorized users.

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“…Second, the intense acoustic reflection from the lumen‐intima interface with calcified plaque in an IVUS image may obscure calcium fractures, especially smaller ones. On the other hand, OCT can detect, localize, and quantify the change of calcium structure in vivo with high resolution and without acoustic shadowing, similar to histology; this includes the depth and number of calcium fractures even poststenting . Thus, we conducted this study using OCT.…”

Section: Discussionmentioning

confidence: 99%

Effect of cutting balloon after rotational atherectomy in severely calcified coronary artery lesions as assessed by optical coherence tomography

Amemiya

Yamamoto

Maehara

et al. 2019

Cathet Cardio Intervent

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Objectives Using optical coherence tomography (OCT), we evaluated the effect of a cutting balloon (CB) compared with a conventional balloon after rotational atherectomy (RA) and before stenting in severely calcified coronary lesions. Background A CB is designed to create discrete incisions to facilitate fracture of severely calcified plaque. Methods OCT was performed preintervention (if possible), post‐RA, and poststent implantation. RA modification of calcium was defined as a polished, concave, round‐shaped surface. Calcium fracture was defined as a break in the calcium plate. The effects of calcium modification and stent expansion between CB (n = 18) versus conventional balloon (n = 23) following RA were compared. Results Median patient age was 72 years with 24% on hemodialysis. The amount of calcium and the length of RA modification were comparable between the CB and conventional balloon groups. Final poststent OCT showed that the number and thickness of calcium fracture were greater after CB versus conventional balloon, resulting better stent expansion (78.9% [IQR: 72.4–88.1] vs. 66.7% [IQR: 55.0–76.7], p < 0.01). In the multivariable model, after adjusting for the amount of calcium, CB use was an independent predictor of the presence of calcium fracture (odds ratio 30.0; 95% confidence interval 2.7–994.1, p = 0.004) and an independent predictor for greater stent expansion (regression coefficient 7.4; 95% confidence interval 0.5–14.3, p = 0.04). Conclusion In severely calcified lesions calcium fracture was more often associated with RA followed by CB compared with RA followed by conventional balloon predilation before stenting. CB use was also a determinant of greater stent expansion.

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Superficial Calcium Fracture After PCI as Assessed by OCT

Cited by 94 publications

References 4 publications

Comparison of clinical outcomes of coronary artery stent implantation in patients with end‐stage chronic kidney disease including hemodialysis for three everolimus eluting (EES) stent designs: Bioresorbable polymer‐EES, platinum chromium‐EES, and cobalt chrome‐EES

Comparison of clinical outcomes of coronary artery stent implantation in patients with end‐stage chronic kidney disease including hemodialysis for three everolimus eluting (EES) stent designs: Bioresorbable polymer‐EES, platinum chromium‐EES, and cobalt chrome‐EES

Optical coherence tomography findings after longitudinal ablation for an underexpanded stent in a heavily calcified lesion: a case report

Effect of cutting balloon after rotational atherectomy in severely calcified coronary artery lesions as assessed by optical coherence tomography

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